NEW DELHI: The Centre on Friday said that 2,359 hospitals have been de-empanelled and over 1,200 suspended by states and Union Territories (UTs) for violating guidelines under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the world's largest government-funded health assurance scheme, as of May 31 this year.
Union Health Minister JP Nadda informed the Lok Sabha that 29 FIRs have been registered and penalties amounting to Rs 328.49 crore imposed for violations of the scheme's guidelines.
He said the scheme follows a zero-tolerance approach towards fraud, with the National Anti-Fraud Unit under the National Health Authority (NHA) using Artificial Intelligence (AI) and Machine Learning (ML)-based automated triggers to detect suspicious claims.
Nadda said these automated checks flag unusual claim patterns, including unauthorised billing, duplicate entries, inflated procedures and misuse of patient identities, within 24 hours of claim submission.
Claims flagged as suspicious are scrutinised before payment, and those confirmed to be fraudulent are rejected, resulting in savings of Rs 676.14 crore as of July 31, 2026, he said.
Besides suspending and de-empanelling hospitals, authorities also impose penalties and lodge FIRs against institutions found violating the scheme's guidelines, the minister added.
The AB-PMJAY, the government's flagship health insurance programme, provides cashless health coverage of up to Rs 5 lakh per family annually for secondary and tertiary care hospitalisation to the bottom 40 per cent of India's population.
The scheme is being implemented across all states and UTs, with several states integrating it with their own health insurance programmes.
During the 2025-26 financial year, 3.75 crore Ayushman cards were issued to eligible beneficiaries, 2.74 crore hospital admissions were authorised, and 5,074 hospitals were empanelled under the scheme, Nadda said.
The Centre also released Rs 8,438.27 crore to states and UTs during the year for the implementation of the scheme.
Nadda said the release of funds is demand-driven and based on utilisation certificates and requirements projected by the states and UTs.
Responding to another question, the minister said that 95.99 crore Ayushman Bharat Health Accounts (ABHA) had been created across the country as of July 31, 2026, including 5.25 crore in Gujarat.
ABHA, a key component of the Ayushman Bharat Digital Mission (ABDM), is a unique 14-digit health identifier that enables citizens to securely access and manage their digital health records across the healthcare ecosystem, he said.
The minister added that parliamentary constituency-wise data on ABHA creation is not maintained.
